Gastric cancer is one of the most common cancers and is a leading cause of mortality worldwide. 1,2 The National Central Cancer Registry of China (NCCR) estimated that there were 679 000 new cases, and more than 498 000 deaths from this disease in China in 2015. 3 There were an estimated 27 000 new cases and 11 140 deaths in the United States in 2019. 4,5 Gastric cancer is a heterogeneous disease, with significant differences in pathological features, biological behaviours and gene expression profiles. Despite advances in diagnosis and treatment, the disease tends to be prevalent in younger patients. The presence of late-stage clinical disease at the time of diagnosis indicates a high risk of recurrence and metastasis, along with poor prognosis. Therefore, elucidation of the molecular mechanisms involved in the tumorigenesis and disease progression of gastric cancer, with the goal of identifying potential biomarkers and therapeutic targets, is an unmet clinical need. The reprogramming of energy metabolism is an emerging hallmark of malignant tumours. 6 This new perspective suggests that malignant tumours are a metabolic disease. Fast-growing tumour

Background Currently, WeChat is widely used in disease education for patients with Crohn’s disease (CD) in China. It is beneficial for the patients to actively engage in their disease management. Methods In this study, we examined the source and expectations of disease information for Chinese CD patients, analysing the content of popular WeChat public accounts and their potential association with medication adherence. Results Between November 24th, 2017 and April 10th, 2018, online questionnaires were sent to CD patients from eight different large urban hospitals in China. In all, 436 patients with CD were surveyed, and 342 patients responded. Patients most frequently visited Baidu (65%) , WeChat (61%) and medical websites such as Haodaifu (35%) when searching for IBD-related information. Among ten WeChat IBD public accounts, the China Crohn’s and Colitis Foundation (CCCF) (73%), “ IBD Academic Officer ” (21%) and “ IBD in love ” (21%) were the most popular. CD patients were most interested in information from the internet about diet and day-to-day health-related living with IBD (83%), an introduction to the disease (80%), and medication advances and side effects (80%). The correlation between the information provided by the top five WeChat public accounts and patients’ expectations was low. Additionally, most patients (64%) had greater confidence in overcoming the disease after learning about CD through their internet searches. Medical adherence was also related to internet access and income ( p < 0.05). Conclusions WeChat has become a major source of information for IBD education in China, but the content of WeChat didn’t fully meet patients’ expectations. Therefore, future initiatives should aim to provide high-quality information that based on patients’ demands.

Background The increasing incidence of inflammatory bowel disease (IBD) has imposed heavy financial burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing patients with IBD about disease treatment budgets and health care strategies. Objective The aim of this study was to evaluate the economic status and medical care access of patients with IBD through the China Crohn’s & Colitis Foundation web-based platform in China. Methods Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat. Participants were asked to complete a 64-item web-based questionnaire. Data were collected by the Wenjuanxing survey program. We mainly focused on income and insurance status, medical costs, and access to health care providers. Respondents were stratified by income and the associations of income with medical costs and emergency visit times were analyzed. Results In this study, 3000 patients with IBD, that is, 1922 patients with Crohn disease, 973 patients with ulcerative colitis, and 105 patients with undetermined colitis were included. During the last 12 months, the mean (SD) direct and indirect costs for per patient with IBD were approximately US $11,668.68 ($7944.44) and US $74.90 ($253.60) in China. The average reimbursement ratios for most outpatient and inpatient costs were less than 50%. However, the income of 85.5% (2565/3000) of the patients was less than ¥10,000 (US $1445) per month. Approximately 96.5% (2894/3000) of the patients were covered by health insurance, but only 24.7% (741/3000) of the patients had private commercial insurance, which has higher imbursement ratios. Nearly 98.0% (2954/3000) of the patients worried about their financial situation. Thus, 79.7% (2392/3000) of the patients with IBD tried to save money for health care and even delayed their medical treatments. About half of the respondents (1282/3000, 42.7%) had no primary care provider, and 52.2% (1567/3000) of the patients had to visit the emergency room 1-4 times per year for the treatment of their IBD. Multivariate analysis revealed that lower income ( P =.001) and higher transportation ( P =.004) and accommodation costs ( P =.001) were significantly associated with the increased number of emergency visits of the patients. Conclusions Chinese patients with IBD have enormous financial burdens and difficulties in accessing health care, which have increased their financial anxiety and inevitably influenced their disease outcomes. Early purchase of private insurance, thereby increasing the reimbursement ratio for medical expenses, and developing the use of telemedicine would be effective strategies for saving on health care costs.

Background Gastrointestinal tumors are a leading cause of mortality worldwide. As shown in our previous study, miR-1290 is overexpressed in colorectal cancer (CRC) and promotes tumor progression. We therefore aimed to explore the potential of circulating miR-1290 as a biomarker for gastrointestinal cancer. Methods A serum miRNA sequencing analysis was performed. Then, circulating miRNA detection technologies were established. The expression of miR-1290 was analyzed in gastrointestinal tumor cell lines and culture supernatants. Expression levels of circulating miR-1290 in clinical samples were examined. Associations between miR-1290 expression and clinicopathologic characteristics were analyzed. Xenograft models were generated to assess the fluctuation in serum miR-1290 levels during disease progression. Results Through miRNA sequencing, we identified that miR-1290 was overexpressed in serum samples from patients with CRC. We confirmed that human gastrointestinal tumor cells express and secrete miR-1290. The circulating miR-1290 levels was up-regulated in patients with pancreatic cancer (PC) (p < 0.01), CRC (p < 0.05), and gastric cancer (GC) (p < 0.01). High miR-1290 expression levels were associated with tumor size, lymphatic invasion, vascular invasion, distant metastasis, tumor differentiation and AJCC stage in patients with PC and CRC. The area under the curve (AUC) was 0.8857 in patients with PC, with 60.9% sensitivity and 90.0% specificity. The AUC was 0.7852 in patients with CRC, with 42.0% sensitivity and 90.0% specificity. In patients with GC, the AUC was 0.6576, with 26.0% sensitivity and 90.0% specificity. The in vivo model verified that the circulating miR-1290 level was significantly increased after tumor formation and decreased after drug treatment. Conclusions Our findings indicate that circulating miR-1290 is a potential biomarker for gastrointestinal cancer diagnosis and monitoring.

BACKGROUND The increasing incidence of inflammatory bowel disease (IBD) has brought heavy cost burdens for Chinese patients; however, data about their financial status and access to health care are still lacking. This information is important for informing IBD patients about disease budgets and health care strategies. OBJECTIVE This study evaluated the economic status and medical care access of IBD patients through the CCCF (China Crohn’s and Colitis Foundation) internet platform in China. METHODS Our study was performed in 14 IBD centers in mainland China between 2018 and 2019 through WeChat platform. Totally 3000 IBD patients consisting of 1922 patients with Crohn’s disease (CD), 973 patients with ulcerative colitis (UC), and 105 patients with undetermined colitis completed the 64-item questionnaires for analysis. Data were collected by the Wenjuanxing survey program on internet. RESULTS The median age of the respondents was 34 years (range 18–73 years). The income of 85.5% of the patients was under ¥10,000 per month. Health medical insurance covered 96.5% of the patients, but only 14.4% of the patients had commercial insurance, which has higher imbursement ratios. During the last 12 months, the outpatient costs for 41.7% of the patients were over ¥20,000, and the inpatient expenses for 30.7% of the patients exceeded ¥50,000. The average reimbursement ratios for most outpatient and inpatient costs were less than 60%. In addition, 61.7% (n=626) of the patients covered biological agents at their own expense without any reimbursement. Approximately half of the respondents (42.7%) had no primary care provider (PCP) (n = 1282), and 52.2% of the patients needed to go to the ER 1-4 times per year because of IBD, lower level of income, higher travel and accommodation costs were significantly associated with ER times More than 50% of the patients were >50 km away from the closest IBD center, and more than 70% of the patients needed >1 hr to get to the closest IBD center. In all, 98.0% (n = 2954) of the patients worried about their financial problems; thus, 79.7% (n = 2392) of the IBD patients sought ways to save money for health care and even delayed their health care or medical treatments. CONCLUSIONS Chinese patients with IBD have enormous financial burdens and difficulties related to health care access, which have increased their economic worries and inevitably influenced their disease management. Advanced measures should be taken to reduce health care spending and improve disease outcomes. CLINICALTRIAL none